Predictors and Outcome of Hypoxemia in Severely Malnourished Children under Five with Pneumonia: A Case Control Design

Abstract

BackgroundThere is lack of information in the medical literature on predictors of hypoxemia in severely malnourished children with pneumonia, although hypoxemia is common and is often associated with fatal outcome in this population. We explored the predictors of hypoxemia in under-five children who were hospitalized for the management of pneumonia and severe acute malnutrition (SAM).MethodsIn this unmatched case-control design, SAM children of both sexes, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) with radiological pneumonia and hypoxemia during April 2011 to April 2012 were studied. SAM children with pneumonia and hypoxemia (SpO2<90%) constituted the cases (n = 37), and randomly selected SAM children with pneumonia but without hypoxemia constituted controls (n = 111).ResultsThe case-fatality was significantly higher among the cases than the controls (30% vs. 4%; p<0.001). In logistic regression analysis, after adjusting for potential confounders such as nasal flaring, head nodding, inability to drink, and crackles in lungs, fast breathing (95% CI = 1.09–13.55), lower chest wall in-drawing (95% CI = 2.48–43.41), and convulsion at admission (95% CI = 3.14–234.01) were identified as independent predictors of hypoxemia in this population. The sensitivity of fast breathing, lower chest wall in-drawing and convulsion at admission and their 95% confidence intervals (CI) to predict hypoxemia were 84 (67–93)%, 89 (74–96)%, and 19 (9–36)% respectively, and their specificity were 53 (43–63)%, 60 (51–69)% and 98 (93–100)% respectively.Conclusion and SignificanceFast breathing and lower chest wall in-drawing were the best predictors of hypoxemia in SAM children with pneumonia. There thus, in resources poor settings where pulse oximetry is not available, identification of these simple clinical predictors of hypoxemia in such children could be reliably used for early O2 supplementation in addition to other appropriate management to reduce morbidity and deaths.

Which clinical signs predict hypoxaemia in young Senegalese children with acute lower respiratory tract disease?

“…12,13 Severe chest-indrawing, which has been less emphasised in clinical studies, 14 was also clearly associated with hypoxaemia. These two signs are characteristic of severe ARI, which was the most prevalent diagnosis.…”

Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh

“…In pneumonic children, hypoxemia may occur as a consequence of impairment of alveolar-arterial oxygen diffusion and concomitant increase in the partial pressure of carbon-dioxide (CO 2 ) due to abnormally lower alveolar ventilation [30], [31]. This phenomenon in SAM children with pneumonia represents very severe illness often with fatal outcome.…”

Respiratory risks from household air pollution in low and middle income countries

“…Severe protein energy malnutrition, particularly severe wasting (low weight for height: weight-for-height Z score <–3), is an important cause of secondary immunodeficiency worldwide, resulting in diminished cell-mediated (T-cell) immunity, immunoglobulin A in secretions, complement concentrations, and phagocytosis 87. Children with severe protein energy malnutrition are at increased risk of infection, including ALRI, and of mortality from ALRI 88–90. Severe protein energy malnutrition also includes severe stunting (low height for age) and reflects chronic malnutrition.…”